title: Use of a hand-assisted laparoscopic surgical technique for closure of an extensive mesojejunal rent in a horse.
abstract: METHODS
  A 7-year-old 573-kg (1,261 -lb) Swiss Warmblood gelding was evaluated because of signs of acute abdominal pain.
  
  
  RESULTS
  Physical examination revealed a markedly distended abdomen with subjectively reduced borborygmi in all abdominal quadrants. A large, gas-distended viscus was present at the pelvic brim preventing complete palpation of the abdomen per rectum. Ultrasonographic evaluation could not be safely performed in the initial evaluation because of severe signs of abdominal pain.
  
  
  RESULTS
  Ventral midline celiotomy was performed, and right dorsal displacement of the ascending colon was corrected. Progressive signs of abdominal pain after surgery prompted repeat ventral midline celiotomy, and small intestinal incarceration in a large, radial mesojejunal rent was detected. The incarceration was reduced, but the defect was not fully accessible for repair via the celiotomy. Repair of the mesenteric defect was not attempted, and conservative management was planned after surgery; however, signs of colic returned. A standard laparoscopic approach was attempted from both flanks in the standing patient, but the small intestine could not be adequately mobilized for full evaluation of the rent. Hand-assisted laparoscopic surgery (HALS) allowed identification and reduction of jejunal incarceration and repair of the mesenteric rent. Although minor ventral midline incisional complications were encountered, the horse recovered fully.
  
  
  CONCLUSIONS
  HALS techniques should be considered for repair of mesenteric rents in horses. In the horse of this report, HALS facilitated identification, evaluation, and repair of a large radial mesenteric rent that was not accessible from a ventral median celiotomy.
authors.affiliation: Swiss Institute of Equine Medicine, Vetsuisse Faculty, University of Bern CH-3012, Bern, Switzerland., Research Station ALP-Haras, Schwarzenburgstrasse 161, 3003 Bern, Switzerland.
authors.forename: Thomas H
authors.initials: TH
authors.lastname: Witte
authors.forename: Markus
authors.initials: M
authors.lastname: Wilke
authors.forename: Christina
authors.initials: C
authors.lastname: Stahl
authors.forename: Vendula
authors.initials: V
authors.lastname: Jandová
authors.forename: Rhea
authors.initials: R
authors.lastname: Haralambus
authors.forename: Reto
authors.initials: R
authors.lastname: Straub
mesh_terms: D000818:Animals; D058733:Hand-Assisted Laparoscopy / Q000379:methods / Q000662:veterinary*; D006734:Horse Diseases / Q000601:surgery*; D006736:Horses; D007579:Jejunal Diseases / Q000473:pathology / Q000601:surgery / Q000662:veterinary*; D007583:Jejunum / Q000601:surgery*; D008297:Male